#EliminateHepC in Canada

Our government has signed up to the World Health Organisation’s target to eliminate viral hepatitis as a public health threat by 2030 – but if we carry on the same path this will not be achieved.

Hepatitis C is a curable disease – and despite medications being available for over three years an estimated 220,000 – 245,000 Canadians are infected with hepatitis C. Unfortunately, around 44% of those individuals are unaware of their status.

We encourage the Public Health Agency of Canada and provincial public health agencies to work together to invest in, and expedite the adoption/implementation of, testing technologies, including point-of-care testing (POCT), across Canada.

We will not achieve elimination without making the testing process for HCV more accessible to all those who desire it. Point-of-care testing (POCT) encompasses diagnostic tests that can be performed by a health care professional, or other qualified personnel, whether that be self-tests administered and completed by the patient themselves in the home or in a community setting (pharmacies, community health clinics, etc.)

3. Access to all hepatitis C medications approved by Health Canada on public drug programs

Current access to HCV treatment in Canada is shaped more by where a person lives than what they need. Canada’s patchwork of 18 publicly funded drug programs results in inequitable access to HCV treatments across the country, such as differential drug co-payments that force people to make choices between treatment and other basic needs such as shelter and food.

The populations living with HCV are not well served in Canada’s patchwork health care system, with separate jurisdictional responsibilities for health in each province and territory, and at the federal level. A complex web of public and private drug coverage, and in some cases lack of coverage, creates inequity, restricting access for many. What medications people can get, at what cost, varies widely, depending on the forms of public and private insurance available to them.

4. Creation of a framework by the pan-Canadian Pharmaceutical Alliance (pCPA) to standardize processes and timelines and add transparency

Through the pCPA, all 13 provinces and territories, as well as the federal government, have been working together to achieve greater value for brand name and generic drugs for publicly funded drug programs.

A lack of standardized timelines for review and price negotiation, both between the manufacturer and the pCPA, and the manufacturer and individual drug formularies across the country, has resulted in bottlenecks in the availability of new medications.

CTAC calls on the pCPA to create a framework to address the lack of standardization around timelines for the negotiation of drugs, enhance transparency around the decision-making process, and ensure all drugs that have a positive recommendation from CADTH and/or INESS proceed quickly to the pCPA negotiating table.

5. Removal of the time delay between the close of pCPA negotiations and the signing of Product Listing Agreements with individual formularies

Innovative treatments need to be available to all Canadians in a timely manner. It is a growing trend that provinces complete pricing negotiations, through the pCPA, yet are waiting several months to put a product on their formulary. It is crucial that the time delay between the close of pCPA negotiations and the signing of Product Listing Agreements with individual formularies is removed to allow timely access to crucial medications.

CTAC acknowledges that much work has been done to try to bring down the cost of HCV therapies. However, the current price still remains quite high and places an economic barrier to some individuals being able to access the medications they need, despite the fact that treating individuals early has also been proven to be cost-effective.

Canada has access to the medications necessary to cure people and eliminate HCV as a public health threat; especially as newly emerging drugs have broadened the populations that could be effectively treated. Therefore, it is imperative that the cost of medication continues to decline in order to maximize the number of individuals being able to access publically funded, curative treatments in a timely manner.

Canada lacks a national, stand-alone hepatitis action plan, and a clear commitment to the well-being and quality of life of people living with HCV. A strategy is needed that sets measurable goals, and is in line with WHO goals and measures of success.

With this would come the need for not just measurable targets but comprehensive and accurate data with an emphasis on the importance of community adding to this and validating the data to help ensure its accuracy. This data will be key to a well-informed, comprehensive, strategic national hepatitis plan/response.

Action Hepatitis Canada (AHC) “AHC endorses CTAC’s calls to action to end hepatitis C. A standalone viral hepatitis strategy that addresses increased testing, access to timely treatment, care and support for the more than 244,000 people in Canada with hepatitis C, many of whom don’t even know they have the virus, is the only way that Canada will meet its WHO commitment to end hepatitis C as a public health threat in Canada by 2030.” Patricia Bacon, Chair, Action Hepatitis Canada

CTAC acknowledges the traditional territories of the First Nations, Métis and Inuit People, on which we are honoured to work, live, learn and play.